Solution: lateral impingement syndrome in the wrong accrete the outer ankle fractures

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable to eliminate lateral impingement syndrome in incorrectly fused fractures outer ankle. Produce osteotomy of the fibula 5-7 mm above the edge of the joint space of the ankle joint. Introducing between fragments of autograft from the distal epimetaphyseal of the tibia. Perform osteosynthesis outer ankle plate. The method can prevent the development of degenerative complications.

The invention relates to arthrology and can be used for the prevention and treatment of deforming arthrosis of the ankle joint.

Among fractures of the ankle are most often found pronation-everione. At the moment of the traumatic impact on the rotation of the foot is oblique or spiral fracture of the fibula, often with torsion distal fragment. The combination of such a fracture with damage to the deltoid ligament leads to the displacement of the outer ankle proximally. Attached to her lateral ligaments of the ankle joint, while remaining intact, entice th of the talus and the tibia in the external part of the joint, denoted in foreign literature as impingement syndrome and characterized by an overload of the lateral division. The right balance in the joint can only be restored through surgery.

The known method of correcting the position of the fragments in the ankle joint, if the wrong fusion and subluxation of the foot in the long term by open reduction and osteosynthesis of various metal constructions. But as a result of retraction of the musculo-ligamentous apparatus of osteoporosis bone simultaneously to eliminate the offset of the outer ankle bone fragments, fused after spiral fracture with shortening rather difficult (1). Therefore, methods have been developed prolonged mechanical position adjustment of fragments ankles.

Closest to the claimed method is decompression of the ankle joint in the Ilizarov by osteotomy of ankle. However, the above operation traumatic due to the combination of osteotomy and sneakerboy fixation of bone fragments, long time. Long-term work with external fixation device causes contractures and secondary destructive changes in the bone tissue (2).

Developed operation eliminates lateral impingement syndrome occurs when the fracture with shortening of the fibula. To do this, the internal access is made by the internal audit Department of the ankle joint is removed, the scars, the proliferation of synovial membrane condition of the deltoid ligament. Next, the Kocher incision exposed the lower third of the fibula. Is a transverse osteotomy of the fibula 5-7 mm above the edge of the joint space of the ankle joint. Bone autograft from the distal epimetaphyseal tibial wedges between the fragments. Is the osteosynthesis outer ankle plate. When you break the deltoid ligament is plastic.

To calculate the magnitude of decompression radiograph in direct projection is based skiagram, and the talus is set relative to the articular surface of the tibia in the correct position, the joint gap is increased to normal size all over. The diastasis between the alleged ends of the bone after osteotomy plus 2-3 mm for hypercorrection and will be the desired value.

After operad 90oin the ankle joint and 160oin the knee.

A plaster cast after 4 weeks since the surgery to shorten the upper third of the leg, creating the possibility of knee motion. Fully the plaster is removed after 8 weeks from the day of the operation. After performing x-ray control the decision is made to restore motion in the ankle joint and the possibility of support, carrying out rehabilitation activities.

The essential difference of our proposed method is that in the transverse osteotomy of the external malleolus at the level of the distal tibiofibular of SYNDESMOS and bone autoplasty defect of cortical-cancellous graft is taken locally, on a pre-calculated value is eliminated as the cause of pain in the external part of the ankle - discongruence articular surfaces.

The method is used in the clinic since 1998. During this time operated 27 patients. After two years, good results were obtained in 77% of cases in the form of the disappearance of pain, recovery support ability of the legs, increase range of motion, improve quality of life.

References

2. Emelyanov Century, Denisov, A., an Integrated approach to the treatment of deforming arthrosis of the ankle joint. In: "Modern methods of treatment and prosthetics for diseases and injuries of the musculoskeletal system". Saint-Petersburg., 1996, S. 101-102.

3. Tarakura Y., Tanaka Y., Kumai, T., Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. Journal of Bone & Joint Surgery - British Volume. 77(1):50-4, Jan 1995.

4. Yoshimine F. Effects of fibular malunion on contact area and stress distribution at the ankle with six simulated loading conditions. Nippon Seikeigeka Gakkai Zasshi - Journal of the Japanese and a French Brasserie Association. 69(7): 460-9, 1997 Jul.

Solution: lateral impingement syndrome in incorrectly fused fractures of the external malleolus, including osteotomy of the fibula, characterized in that produce transverse osteotomy of the fibula 5-7 mm above the edge of the joint space of the ankle joint, introducing between fragments of autograft from the distal epimetaphyseal tibia, perform osteosynthesis outer ankle plate.

 

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